IV Fluids

Question 1

What is the definition of diffusion?

Answer 1

The movement of solute from high to low concentration (membrane must be permeable to solute)

Question 2

What is the definition of osmosis?

Answer 2

The movement of water from high to low concentration (membrane has to be solute impermeable)

Question 3

What is the definition of osmolarity?

Answer 3

The measure of solute concentration per unit volume of solvent

Question 4

What is the definition of osmolality?

Answer 4

The measure of solute concentration per unit volume of MASS of solvent

Question 5

Is Osmolality the same between ICF and ECF? Why?

Answer 5

Yes - because water moves freely across cell membranes

Question 6

What is the definition of tonicity?

Answer 6

The measure of the oncotic pressure gradient between two solutions

Question 7

Which type of solutes are taken into account in the computation of tonicity? Solutes that CAN or CANNOT cross the semipermeable membranes?

Answer 7

CANNOT

Question 8

How much water does the average 70kg male body carry?

Answer 8

42l

Question 9

How much of bodily fluid is ICF and how much is ECF?

Answer 9

ICF - 2/3

ECF - 1/3

Question 10

How much of the ECF is contained within plasma?

Answer 10

20%

Question 11

What are the components of blood?

Answer 11

Plasma + cells (white & red) + platelets (clotting)

Question 12

What solutes are found within plasma?

Answer 12

Na

Mg

Cl

K

Question 13

Apart from solutes (electrolytes), what else is found within plasma?

Answer 13

Urea

Protein

Bilirubin

Question 14

Which solute has the highest concetration within ICF?

Answer 14

Potassium

Question 15

Which solute has the highest concentration within ECF?

Answer 15

Sodium

Question 16

What are the 2 components of fluid found with the ECF?

Answer 16

1 - Interstitial compartment

2 - Plasma compartment

Question 17

Is osmolality the same between all fluid compartments in the body?

Answer 17

Yes

Question 18

What are the bodies daily requirements for water, sodium, potassium and glucose?

Answer 18

Water - 25/30ml/kg/day

Sodium - 1mmol/kg/day

Potassium - 1mmol/kg/day

Glucose - 50-100g/day

Question 19

How much of fat is composed of water?

Answer 19

10%

Question 20

How much of muscle is composed of water?

Answer 20

75%

Question 21

Does the body need less or more water as we get older?

Answer 21

Less

Question 22

What are the important questions to ask yourself when assessing a patient who may need fluids?

Answer 22

1 - What is the fluid status of my patient?

2 - Does my patient need IV fluids?

3 - How much fluid does my patient need?

4 - What type of fluid does my patient need?

Question 23

What is the first step in assessing your patients fluid status?

Answer 23

Identify the cause of the deficit/surplus:

A - Airway

B - Breathing

C - Circulation

D - Disability

E - Extremities

Question 24

What are the possible fluid status’s of patients?

Answer 24

Hypovolaemic

Euvolaemic

Hypervolaemic

Question 25

What are the features of euvolaemic patient?

Answer 25

1 - Does not feel thirsty 2 - Warm extremities 3 - Well filled veins 4 - Normal HR & BP 5 - Normal urine 6 - Mild sweat

Question 26

What are the features of a hypovolaemic patient?

Answer 26

1 - Feels nauseous & thirsty 2 - Flat veins 3 - Cool peripheries 4 - No sweat 5 - Low or postural BP and high HR 6 - Low urine output 7 - Confusion

Question 27

What does a hypovolaemic patient need?

Answer 27

1 - Resuscitation fluids (if BP low) 2 - Rehydration fluids 3 - "Plug the leak"

Question 28

What are the features of a hypervolaemic patient?

Answer 28

1 - Breathless 2 - Distended veins 3 - Warm and oedematous extremities 4 - Sweaty 5 - High BP & HR 6 - Dilute urine

Question 29

What does a hypervolaemic patient need?

Answer 29

1 - Diuretics (if respiratory system is compromised) 2 - Haemofiltration (if anuric)

Question 30

In what case can hypovolaemic patients become oedematous?

Answer 30

- **Low Albumin** or **Protein** levels (causes low oncotic pressure and therefore loss of intracapillary pressure) - Patients become oedematous but have features of hypovolaemia (**low BP, high HR** and **thirsty**)

Question 31

What needs to be considered when computing how much fluid your patient needs?

Answer 31

1 - Catheters/drains 2 - Input charts 3 - Vomit bowls 4 - Sputum pots 5 - Stool charts and stoma losses

Question 32

Via which routes can patients loose 'insensible' water?

Answer 32

1 - Sepsis (sweat) 2 - Ventilation 3 - Open wounds 4 - Bleeding 5 - Burns

Question 33

What is the normal volume of insensible fluid losses in humans per day?

Answer 33

400-800mls

Question 34

What are the routes via which fluid can be adminstered to a patient?

Answer 34

IV Oral NG

Question 35

What are the different fluid types that can be adminstered to patients?

Answer 35

1 - Dextrose 2 - Crystalloids 3 - Plasma expanders

Question 36

For what reasons can patients need IV fluids?

Answer 36

**Resuscitation** - IV fluids urgently to restore circulation with hypovolaemia **Routine maintenance** - If patient cannot take fluids orally or parenterally **Replacement** - Not as urgent as IV resuscitation, but need additional fluids ontop of maintenance due to external losses e.g. diarrhoea, fever **Redistribution** - For patients with abnormal fluid distribution (sepsis, cardiac, liver or renal disease)

Question 37

What are the features of dextrose?

Answer 37

1 - Moves through all compartments of the body 2 - Zero sodium load 3 - Isotonic

Question 38

When should dextrose fluid be used?

Answer 38

1 - Chronic dehydration 2 - Hypernatraemia

Question 39

When should dextrose not be used?

Answer 39

1 - Fluid resuscitation 2 - Low albumin

Question 40

What are the features of crystalloid fluids?

Answer 40

1 - Very practical 2 - Remains in ECF 3 - High Na load

Question 41

In what situations are crystalloid fluids useful?

Answer 41

1 - Acute dehydration 2 - AKI 3 - Resuscitation

Question 42

In what situations are crystalloid fluids not useful?

Answer 42

1 - Long term maintenance 2 - Hypernatraemic patient

Question 43

What are the features of plasma expanders?

Answer 43

1 - Stays in IVS 2 - Similar efficacy to crystalloids for resuscitation 3 - Sometimes used in Liver Cirrhosis

Question 44

In what situations are plasma expanders useful?

Answer 44

1 - Liver patients

Question 45

What are the 3 fluid compartments in humans?

Answer 45

1 - ICF 2 - Interstitial fluid (ECF) 3 - Plasma fluid (ECF)